Manifestations of Bronchogenic carcinoma (clinical picture)

A change in the character of the regular cough of a smoker old male, particularly if it is associated with other new respiratory symptoms, should raise the possibility of bronchogenic carcinoma.

I-Thoracic manifestations of Bronchogenic carcinoma

A- Bronchopulmonary presentations:
1- Asymptomatic (detected accidentally by routine x-ray as coin shadow)
2- Cough and haemoptysis :
 Blood tinged sputum - Red current jelly  i.e. sputum consist of  Mucous, Tissue debris, RBCs

3- Bronchial obstruction
• Partial      ==> Emphysema , Bronchiectasis
• Complete ==> Lung collapse
Bronchogenic-carcinoma

4- Pneumonia usually recurrent at the same site, or is slow to respond to treatment.

5- Lung abscess (due to secondary infection)
6- Thoracic inlet syndrome may occur due to bronchial carcinoma in the apex of the lung (superior sulcus tumour) causing invasion of :
• Upper 3 ribs
• Sympathetic chain ===> Horner syndrome
                                                                    - Ipsilateral partial ptosis.
                                                                    - Ipsilateral enophthalmos and a small pupil
                                                                    - Ipsilateral hypohidrosis of the face.
• SVC obstruction (congested non pulsating neck veins)
• Lower trunk of brachial plexus (Pancoast's syndrome) :
- Pain in shoulter and inner -  Wasting of the smal1 muscles of the hand
• Subclavian artery ===> unequal pulse volume in both upper limbs .

7- Cor pulmonale due to lymphangitis carcinomatosa.

B - Pleural presentations:

* Effusion :
• Malignant effusion (Exudate) : Massive ,Hemorrhagic, Rapidly re-accumulating

Transudate : due to obstruction of azygos vein .
Chylous : due to obstruction of the thoracic duct .
Empyema : due to rupture of malignant abscess into pleura .

* Dry pleurisy may occur

C - Mediastinal presentations:
Mediastinal spread may result in dysphagia .

• Hypercalcemia is usually caused by squamous cell carcinoma.
• Syndrome of inappropriate ADH and ectopic ACTH seretion are usually associated with small cell carcinoma.
• Clubbing most often with non small cell carcinoma.
• Gynecomastia is usually with large cell carcinoma.
• Hypertrophic pulmonary osteoarthropathy is usually with adenocarcinoma.
• Neurological syndromes may occur with any type of bronchial carcinoma.

II- Extra-thoracic manifestations of Bronchogenic carcinoma

bronchogenic-carcinoma

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